title: Enrollment of patients with lung and colorectal cancers onto clinical trials.
abstract: OBJECTIVE
  Only 2% to 5% of adult patients with cancer enroll onto clinical trials. We assessed simultaneously characteristics of patients and their physicians that may be independently associated with participation.
  
  
  METHODS
  CanCORS, a National Cancer Institute (NCI) -funded population-based observational cohort study of newly diagnosed patients with lung and colorectal cancers, sampled patients across five geographic areas, five health care delivery systems, and 15 Veterans Administration hospitals. We linked patient survey and medical record data with physician survey data to examine correlates of trial enrollment.
  
  
  RESULTS
  Among 9,901 patients, 5.3% enrolled onto trials. Of the 9,901 patients, we linked 6,506 patients to one medical oncologist, surgeon, or radiation oncologist (physicians, N = 1,325) who responded to the physician survey and was considered their primary cancer clinician decision maker. Patient age, race, disease stage, geographic region, and health insurance were independently associated with trial enrollment. Physician factors independently associated with patient trial enrollment were being a medical oncologist, practicing at an NCI-designated cancer center, taking the lead in discussing trials with patients, and receiving increased income from trial enrollment. After simultaneously adjusting for patient and physician characteristics, only being a physician practicing at an NCI-designated cancer center (odds ratio [OR], 1.65; 95% CI, 1.19 to 2.27) and patient female sex (OR, 1.36; 95% CI, 1.10 to 1.68), age > 70 versus < 50 years (OR, 0.28; 95% CI, 0.16 to 0.48), and advanced disease (OR, 1.85; 95% CI, 1.45 to 2.37) remained independently associated with trial enrollment.
  
  
  CONCLUSIONS
  Both practice environment and patient clinical and demographic characteristics are associated with cancer clinical trial enrollment; simultaneous intervention may be required when trying to increase enrollment rates.
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA. mfouad@uab.edu
authors.forename: Mona N
authors.initials: MN
authors.lastname: Fouad
authors.forename: Jeannette Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Vogt
authors.forename: Syed Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.forename: Dee W
authors.initials: DW
authors.lastname: West
authors.forename: Christian
authors.initials: C
authors.lastname: Simon
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003625:Data Collection; D003710:Demography; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012737:Sex Factors; D013038:Specialization; D055815:Young Adult